**4. Conclusions**

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

suspicion of peripheral sensorial neuropathy [106].

*3.3.1.3 Assessment of the severity of the infection*

treatment [86, 96, 97].

**3.4 DFU management**

*3.4.1 Prophylaxis of DFU*

important [86, 96, 97].

*3.3.1.1 Peripheral neuropathy screening*

*3.3.1.2 Peripheral arterial disease*

threshold (VPT) with a neurothesiometer [93–95, 102, 103]. Tendon reflexes and muscular strength are also a part of the examination [95–99]. Finally, sudomotor dysfunction (reduced sweat production) is best examined by the Neuropad indicator test, which is based on a colour change from blue to pink [96, 97]. Indeed, this test has recently been identified as an independent risk factor of DFUs at 5 years [104].

Evaluation of bilateral sensorial neuropathy in clinical practice requires neurological trained specialist and electrophysiological tests, which an increased burden on the national healthcare systems. In order to better select the patients who are more probably affected by neuropathy, a simpler tool was developed in 1994, namely Michigan Neuropathy Screening Instrument (MNSI) [105, 106]. It comprises a 2-step evaluation: first, a 15-item self-administered questionnaire that is scored by summing abnormal responses, followed by lower extremity examination (deformities, non-healing ulcers), assessment of ankle reflexes and of vibratory sensation. According to Herman and col., a score of more than 4 should raise the

Documenting the presence and the severity of ischemia is extremely important. Examination includes: a) palpation of peripheral pulses at the dorsalis pedis and the posterior tibial arteries; b) measurement of the ankle-brachial index (ABI) by a Doppler device [99, 100]. ABI evaluates the ratio of systolic arterial pressure at the brachial over the ankle level [107, 108]. Normal values range between 0.9-1.3, while values exceeding 1.3 point to calcified, uncompressible arteries, in which case the test cannot be used [99]. Similarly, one may measure the toe-brachial index (TBI), given that small digital arteries are rarely calcified: TBI<0.7 confirms the diagnosis of PAD [108]. More sophisticated evaluation (ultrasound, angiography) are used

If infection is suspected, it is best to use a tissue culture to identifying pathogens

[109, 110]. X-rays, computed tomography and magnetic resonance imaging are used to evaluate bone infection or abscess formation, as well as to guide surgical

Patients at risk of DFU should be managed by an interdisciplinary approach, including a diabetologist, a vascular surgeon, a podiatrist, a general surgeon, an orthopedic surgeon, a plastic surgeon and other specialists [82, 94, 102]. Stringent glycemic control is essential both in primary prevention of DFU and in ensuring wound healing. Management of high blood pressure and dyslipidemia is also

High-risk patients need education about the importance of wearing comfortable footwear, rigorous local hygiene, keeping feet dry and avoiding possible causes of local trauma (including barefoot walking) and frequent self-examinations [86, 96, 97]. Callus debridement, off-loading, and correct treatment of nail pathology are simple but

when necessary, especially to guide interventional treatment [95–99].

**266**

Diabetic retinopathy and diabetic foot ulcer are both disabling complications, with a significant impact on the patient's quality of life and healthcare systems [118]. Microvascular impairment and local inflammation play a significant role in the both pathological mechanisms. Prevention and early detection, along with optimal control of blood sugar, hyperlipemia and arterial hypertension are the most efficacious measures against these fearful complications.
